Provider Demographics
NPI:1467438341
Name:LONGEST, CEREESA E (MD)
Entity Type:Individual
Prefix:DR
First Name:CEREESA
Middle Name:E
Last Name:LONGEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 W CENTRAL RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2402
Mailing Address - Country:US
Mailing Address - Phone:847-253-4040
Mailing Address - Fax:847-253-3028
Practice Address - Street 1:1100 W CENTRAL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2402
Practice Address - Country:US
Practice Address - Phone:847-253-4040
Practice Address - Fax:847-253-3028
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090336207WX0110X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621679OtherBCBS OF IL
IL036090336Medicaid
IL036090336Medicaid
IL01621679OtherBCBS OF IL